ABSTRACT Although studies of patients seen in emergency department (ED) settings have documented a strong association of alcohol with injury, such patients are not necessarily representative of the larger population, and less is known of alcohol's association with risk of injury in patient samples outside the ED.
Drinking before injury was analyzed in the 2005 National Alcohol Survey among the 1,149 respondents (18.5%, weighted) who reported an injury during the past year; analysis was by injury treatment type (ED-treated, 29.2%; other-treated, 47.8%; and nontreated, 22.9%).
Based on case-crossover analysis, the relative risk of injury from drinking was 1.85 (p < .01) for those with an ED-treated injury, 1.42 (ns) for those with an other-treated injury, and 1.43 (ns) for those with a nontreated injury. Alcohol-attributable fractions based on these relative risk estimates were 2.96% for an ED-treated injury, 1.59% for an other-treated injury, and 1.89% for a nontreated injury. Comparative attributable fractions based on the person's causal attribution of injury to his or her drinking were 3.06%, 1.61%, and 1.47%, respectively. Although these attributable fractions based on case-crossover analysis and subjective evaluation of causal attribution were not greatly different, all estimates were considerably smaller than those found in studies of ED patients.
The data suggest that alcohol plays a larger role in those injuries for which treatment is sought in EDs, and this may be related to the severity of the injury. Additional studies of alcohol and injury in general populations that take into account the intensity of exposure to alcohol before the event, as well as recall bias by eliciting data on the proximity of the event to the time of the respondent interview, are necessary for determining unbiased estimates of the attributable fraction of alcohol in injury morbidity.

[Show abstract][Hide abstract]ABSTRACT: Brief interventions have been shown to reduce alcohol use and improve outcomes in hazardous and harmful drinkers, but evidence to support their use in emergency department (ED) patients is limited. The use of research assessments in studies of brief interventions may contribute to uncertainty about their effectiveness. Therefore we seek to determine (1) if an emergency practitioner-performed Brief Negotiation Interview or a Brief Negotiation Interview with a booster reduces alcohol consumption compared with standard care; and (2) the impact of research assessments on drinking outcomes using a standard care-no-assessment group.
We randomized 889 adult ED patients with hazardous and harmful drinking. A total of 740 received an emergency practitioner-performed Brief Negotiation Interview (n=297), a Brief Negotiation Interview with a 1-month follow-up telephone booster (Brief Negotiation Interview with booster) (n=295), or standard care (n=148). We also included a standard care with no assessments (n=149) group to examine the effect of assessments on drinking outcomes. Primary outcomes analyzed with mixed-models procedures included past 7-day alcohol consumption and 28-day binge episodes at 6 and 12 months, collected by interactive voice response. Secondary outcomes included negative health behaviors and consequences collected by telephone surveys.
The reduction in mean number of drinks in the past 7 days from baseline to 6 and 12 months was significantly greater in the Brief Negotiation Interview with booster (from 20.4 [95% confidence interval {CI} 18.8 to 22.0] to 11.6 [95% CI 9.7 to 13.5] to 13.0 [95% CI 10.5 to 15.5]) and Brief Negotiation Interview (from 19.8 [95% CI 18.3 to 21.4] to 12.7 [95% CI 10.8 to 14.6] to 14.3 [95% CI 11.9 to 16.8]) than in standard care (from 20.9 [95% CI 18.7 to 23.2] to 14.2 [95% CI 11.2 to 17.1] to 17.6 [95% CI 14.1 to 21.2]). The reduction in 28-day binge episodes was also greater in the Brief Negotiation Interview with booster (from 7.5 [95% CI 6.8 to 8.2] to 4.4 [95% CI 3.6 to 5.2] to 4.7 [95% CI 3.9 to 5.6]) and Brief Negotiation Interview (from 7.2 [95% CI 6.5 to 7.9] to 4.8 [95% CI 4.0 to 5.6] to 5.1 [95% CI 4.2 to 5.9]) than in standard care (from 7.2 [95% CI 6.2 to 8.2] to 5.7 [95% CI 4.5 to 6.9] to 5.8 [95% CI 4.6 to 7.0]). The Brief Negotiation Interview with booster offered no significant benefit over the Brief Negotiation Interview alone. There were no differences in drinking outcomes between the standard care and standard care-no assessment groups. The reductions in rates of driving after drinking more than 3 drinks from baseline to 12 months were greater in the Brief Negotiation Interview (38% to 29%) and Brief Negotiation Interview with booster (39% to 31%) groups than in the standard care group (43% to 42%).
Emergency practitioner-performed brief interventions can reduce alcohol consumption and episodes of driving after drinking in hazardous and harmful drinkers. These results support the use of brief interventions in ED settings.

[Show abstract][Hide abstract]ABSTRACT: While emergency room (ER) studies have documented a strong association of alcohol with injury, these studies are not necessarily representative of the general population. To evaluate comparative risk of injury from drinking for those treated in the ER with non-ER-treated injuries (those treated elsewhere or those not treated), data on alcohol and injury are analyzed in the U.S. general population by type of injury treatment.
Relative risk (RR) of injury from drinking within 6 hours prior to the event was analyzed using case-crossover analysis based on respondents' usual frequency of drinking in 4 (1995 to 2010) National Alcohol Surveys (n = 4,819).
RR was 1.01 for the total injured and significantly elevated for ER-treated injured (1.46), but not for those treated elsewhere (0.75) and those not treated (1.02). RR was significantly elevated for those aged 18 to 30 years (1.45; 1.14, 1.85), Blacks (1.54; 1.11, 2.14) and Hispanics (1.98; 1.51, 2.59), those positive on the Rapid Alcohol Problems Screen (RAPS4) as a measure of alcohol dependence (2.41; 1.86, 3.11), and for motor vehicle injuries (2.61; 1.49, 4.58) or cutting/piercing injuries (2.04, 1.10, 3.81). For those reporting ER-treated injuries, significant effect modification was found for those aged 18 to 30 years (RR = 2.29), Blacks (RR = 2.59) and Hispanics (RR = 2.68), high risk-taking (RR = 1.71), positive RAPS4 (RR = 3.69), and for motor vehicle (RR = 3.79) and cutting/piercing injuries (RR = 2.60).
Data suggest alcohol plays a larger role in injuries for which ER treatment is sought than for other injuries, and estimates for injury from drinking derived from ER studies may be elevated. Future general population studies should take into account intensity of exposure to alcohol prior to injury, potential recall bias (by eliciting data on the proximity of injury to time of the respondent interview) and severity of injury, for improving estimates of the attributable burden of alcohol to injury in society.

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